FAQ Category: Lumbar Spine

Coccygodynia means “pain in the coccyx.” The coccyx is the end of the spinal column or “tailbone.” Risk factors for coccygodynia include obesity, trauma, or childbirth. Coccygodynia is most common when any of these factors are combined together.

Coccygodynia is much more common in women than men. It can occur at any age, but seems to develop more often during midlife. Fracture or bruising after a difficult birth is a common history given.

Some patients have coccygodynia without trauma. In these cases tight or spastic muscles, arthritis, or tumors may be the cause.

Low back pain is the most common complaint among amateur and professional golfers. The modern swing puts a lot of torque on the leading hip. If you don’t have enough rotation in that hip the force of the motion gets translated through the hip to the sacroiliac
joint or the low back.

Several studies show golfers with more outward hip rotation than inward rotation are more likely to have back pain. Experts in preventing and managing golf injuries advise stretching the hip and lumbar spine. There are no studies to prove this works yet, but until proven otherwise, it’s considered good advice.

Stenosis or narrowing of the spinal canal can be treated without surgery. Medications and exercise are the first treatment methods used. This is called conservative
therapy.

Surgery isn’t conservative and is called invasive because it means cutting into the body. You’re right about the trend toward less invasive operations. Smaller incisions can be used with today’s improved technology.

The surgeon can use tools inside the body with tiny TV cameras on the ends. This gives a view inside the body without actually cutting open the spine. At the same time, surgeons know more about what works and what doesn’t.

Smaller cuts and removing less tissue are just as effective as the more invasive surgery years ago. Instead of removing all of the bone or joint around the spinal canal, only part of the tissue is taken out. This is called a partial lamiarthrectomy. It replaces the full laminectomy and complete arthrectomy used a decade ago.

Reports from all three countries show a wide range of success (or failure depending on how you look at it).

In some studies, almost half the patients reported sciatica down the leg after lumbar disc surgery. As many as 70 percent report residual low back pain. Weakness and loss of function are also problems reported after lumbar disc surgery.

Low estimates place these figures around 22 percent for post-operative sciatica and 30 percent of continued low back pain. Researchers around the world are trying to find risk factors for a poor result. Doctors would like to be able to assess risk factors and predict who will have a good result.

For now there’s no reason to go anywhere else for this operation. The results are the same on both sides of the continent and ocean.

You are noticing a fairly common response in some patients. Their beliefs and expectations dictate their pain more than the actual condition. Many studies report similar findings. It doesn’t seem to matter what the problem is: irritable bowel, angina, fibromyalgia, headaches, and so on. How the patient interprets the pain is the key.

Researchers also report greater pain and drug use when symptoms occur after an injury or trauma. You may want to talk with your father and his doctor about his need for drugs and
the best kind to take for his symptoms.

This does seem like a puzzle. Patients being treated for cancer who are so tired ask the same question. However, exercise has been proven to work for both problems: back pain and fatigue! In fact, when it comes to back pain, there’s no evidence that the back pain gets worse with exercise. It frequently gets better!

Exercise should begin slowly. It may be best for you to start on a day when you are having some pain so you won’t overdo. There are three exercise goals for patients with chronic back pain of unknown cause. The first is to improve flexibility and strength. The second is to reduce how strong the pain is (the intensity). The third is to increase function even if pain doesn’t go away. In other words the patient will be able to do more even though it still hurts.

Many, many studies have shown exercise is the key to overcoming back pain. If you need help getting started, see a physical therapist. You can get set up on a home program with monitoring as often as you need it.

Yes. If you do it! Regardless of where exercise takes place, you get the full benefit. There are two advantages to exercising at a fitness center. First you are more likely to exercise if you have to pay for the gym. You are also more likely to go to the gym if you
set up a regular time to exercise.

Many things can interrupt exercising at home. Since you are by yourself, you aren’t as likely to do as much exercise as when there is a class or some other kind of supervision. Finally in a gym or fitness center you’ll gain the support you need to stick with the program. If you don’t show up, someone may ask, “Where were you? We missed you.” This may motivate you to keep coming back even after you miss a day.

The results of hundreds of studies show that exercise has a slight protective effect against back pain for the general population. This doesn’t mean you can’t injure yourself
or overdo it and end up with back pain.

Even in these cases, exercise is often the best treatment. There’s no proof that exercise increases your risk of back pain. Regular exercise even when you have back pain is safe. Scientists think exercising will reduce your risk for future back problems. Some studies
show workers who exercise take fewer sick days.

Research also shows fewer reinjuries and sick days taken by workers with back pain who continue to exercise regularly. Your best bet is to get back to an exercise program slowly and build back up to your previous level.

Every study has certain criteria each subject must meet to be a part of the study. Sometimes this inludes age, gender, type of symptoms, or failure to get better with nonoperative care.

When patients with disc problems are studied, researchers often look for patients who don’t have any other problems or who don’t have any other symptoms. Anyone with back pain
that goes down the leg may be excluded. In some cases, subjects end up needing surgery and must drop out. Others injure themselves again or even die before the study is over.

You may wish to call the department sponsoring the study and find out more of the details.

Probably not without the researchers telling you. When patients are asked which group they thought they are in, most believe they are receiving the active treatment. Only a small number say they can’t tell or thought they were in the sham (pretend) treatment
group.

Studies show many people in the control group (group that doesn’t get real treatment) get better anyway. This is called a placebo effect. In these studies, patients in both groups are followed for months to years after the treatment. The researchers look for long-term effects in order to measure the treatment against the placebo effect.

When you sign up to be a part of any study, the researchers usually go over these details very carefully. Subjects usually know they may not be getting the real treatment.

In the most ethical practice, patients are unblinded at some point. This means
they are told which group they were really in. Any patient who wasn’t treated but still has pain or symptoms then has the option of seeking additional treatment.

It sounds like you were in the control group (untreated), but you were unblinded after six months. You very likely agreed to this, or you wouldn’t have been included in the study. If you have any doubts, ask to see the paperwork you signed at the beginning of
the study.

Unfortunately, this is true. Many studies have shown that the strongest predictor of future back pain is a current (or previous) episode of back pain. In fact, people who’ve
had low back pain (LBP) have twice the rate of new LBP compared to people who’ve never had LBP.

The more often you have back pain, the greater your risk of new back pain. What’s not clear is whether the new back pain is really new or just a recurrence of the old back pain. It’s possible that patients don’t fully recover, and they go on to reinjure themselves.

Studies show that previously injured spinal structures are at risk for reinjury. It looks like repeated or excessive loading on already damaged soft tissues can cause a problem disc to wear out faster. The result can be chronic low back pain (LBP).

Certain work tasks also increase the risk of LBP. Compression and shear forces in the spine that occur during lifting seem to be the biggest factor in reinjury. A recent study from Ohio State University tried to find out which activities or work tasks increase
spine loading. The idea is to restore normal motion when using these movements.

The researchers found that previously injured workers change the way they lift objects. There is increased muscle holding and guarding. The workers are unwilling to load the spine fully. Many of these workers are also heavier and larger than subjects without back
pain. This puts an extra load on the spine.

Future rehab programs may be able to use computers to monitor muscle contractions. A software program will help patients regain normal motions.

More and more studies show it doesn’t matter how some kinds of back pain is treated. It goes away in about the same amount of time for everyone. The use of painkillers has been called into question because of these findings. Doctors may prescribe drugs when patients insist on taking something, and other medications have been tried.

Likewise, X-rays don’t show much when the cause of back pain is unknown. Efforts to reduce costs of back care have resulted in fewer X-rays being taken. The use of MRIs (magnetic resonance imaging) is on the rise, but it’s not clear whether these show any
more than X-rays in cases of general back pain.

Some doctors suggest a “wait and see” approach. Use painkillers, rest when needed, and activity at all other times. Pain that doesn’t go away or gets worse can be further investigated with more expensive imaging studies. A trip to the emergency room is not usually cost effective. You’re better off sticking with a doctor who knows you and your case.

I read a report in a runner’s magazine about what kind of muscle fibers are present in people who have chronic low back pain compared to normal, healthy adults. All of the
subjects were men. Why aren’t women included in these kinds of studies?

There are gender differences for muscle performance and muscle fiber-type. To help keep the research “pure” scientists may choose to include only one gender type. This allows them to compare apple with apples instead of apples with oranges. In some studies, the topic under study isn’t different from men to women, so both are included.

Most likely, yes. Surgeons have a general rule. It’s better to find out there isn’t internal bleeding by doing a second procedure than to wait too long and lose the patient. Damage to the blood vessels after spine surgery is rare, but it can be fatal.

In a recent study of just such cases, doctors had a zero percent (0%) mortality rate during 12 years of follow-up after spine surgery. They say this success is because they watched for low blood pressure after the operation. They also didn’t hesitate to look for
a damaged blood vessel causing hemorrhage.

Out of 3614 cases of lumbar spine surgery in this hospital study, only three were false negatives. In those three cases, no blood vessels were injured causing the patients
symptoms. The second operation was needed to make sure of that.

An aneurysm is a weakness and thinning of a blood vessel wall. Blood flowing past this weak area can push against this spot and form a bulge. Sometimes the lining of the blood vessel wall tears and blood goes down between the two layers. This is called a
dissecting aneurysm.

A false aneurysm (also called pseudoaneurysm) is a leakage of blood from an artery into the nearby tissue. There’s an actual hole through all layers of the artery. Blood spurts out of the hole and collects in a cavity that’s walled off.

The leak can result from an artery being punctured during a test such as a cardiac catheterization or an arteriogram. It can also occur during surgery of the spine. The large blood vessel called the aorta is very close to the spine. The artery can be easily damaged during an operation.

Some pseudoaneurysms heal without treatment. Others need to be repaired to prevent too much blood loss.

There are many tools available to measure the results of treatment for low back problems. Most of these are based on questions asked before and after treatment. Status of general
health is usually part of the survey. Identifying other health or physical problems is part of the process.

The most commonly used health screening tools in use are:

Spondylolysis refers to a defect in one of the lumbar vertebra. There are five vertebrae in the low back area. The last one (L5) is affected most often. In spondylolysis there’s a crack or fracture of the pars interarticularis. This area
of the bone is a support structure between the main body of the vertebra and the spinal joints called facet joints.

Spondylolysis occurs in about six to seven percent of the adult population. This is just about the same in children and adults. In about 80 percent of patients with spondylolysis the body of the vertebra with the crack slips forward over the vertebra below it. This is called spondylolisthesis.

If we didn’t there’s a lot of research that would never get done or reported. Assessing skills based on self-report is both reliable and valid.

You can find out more about this with a study published back in 1987 [Jette AM: The Functional Status Index: Reliability and Validity of a Self-Report Functional Disability Measure. Journal of Rheumatology. 14 (Supplement 15). Pp. 15-19].